Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 111N00000X | Chiropractor | | 1525 | MARYLAND | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 47942219 003 | OTHER | MARYLAND | CIGNA HMO |
| 2 | 4794219 002 | OTHER | MARYLAND | CIGNA PPO |
| 3 | 483L 429C | MEDICARE ID-TYPE UNSPECIFIED | MARYLAND | |
| 4 | T289 0001 | OTHER | MARIANA ISLANDS | BC FEP |
| 5 | 5870444 | OTHER | MARYLAND | AETNA PPO POS |
| 6 | 2174552 | OTHER | MARYLAND | AETNA HMO |
| 7 | 427879 | OTHER | MARYLAND | ALLIANCE |
| 8 | U20683 | MEDICARE UPIN | MARYLAND | |
| 9 | 147743500 | OTHER | MARSHALL ISLANDS | FEDERAL WC |
| 10 | LK96GR | OTHER | MARYLAND | BLUE CROSS MD |
